His-bundle capture verification and monitoring

Abstract

This document discusses, among other things, a system and method for generating a stimulation energy to provide His-bundle stimulation for a cardiac cycle, receiving electrical information from the heart over at least a portion of the cardiac cycle, determining a characteristic of at least a portion of the received electrical information for the cardiac cycle, and classifying the cardiac cycle using the determined characteristic.

What is claimed is: 
     
       1. A system comprising:
 a cardiac stimulation circuit configured to generate a stimulation energy to provide His-bundle stimulation for multiple cardiac cycles; 
 a cardiac sensing circuit configured to receive electrical information from the heart over at least a portion of the multiple cardiac cycles; 
 a processor configured to determine characteristics of the received electrical information from the heart over the at least a portion of the multiple cardiac cycles using the received electrical information, the characteristics corresponding to individual ones of the multiple cardiac cycles; 
 wherein the processor is configured to classify each cardiac cycle of the multiple cardiac cycles as a capture type using the respective determined characteristics, wherein the classifying includes distinguishing, for each cardiac cycle, a His-bundle capture type from (1) a myocardium-cell-to-myocardium-cell capture type, (2) an AV node capture type, and (3) a fusion capture type, the fusion capture type including at least partial intrinsic cardiac function fused with at least one of partial His-bundle capture, myocardium-cell-to-myocardium-cell capture, and AV node capture; and 
 wherein the processor is configured to identify a His-bundle capture percentage using information about the classified cardiac cycles. 
 
     
     
       2. The system of  claim 1 , wherein at least one of the characteristics of the received electrical information includes at least one of:
 (1) a correlation of the received electrical information to at least one of a myocardium capture template or a His-bundle capture template; 
 (2) a measure of a heart hemodynamic condition; 
 (3) a vector of a QRS complex; or 
 (4) a morphology of the QRS complex. 
 
     
     
       3. The system of  claim 1 , wherein the classifying includes distinguishing, for each cardiac cycle, the His-bundle capture type from two or more of:
 (1) a myocardium-cell-to-myocardium-cell capture type, 
 (2) an AV node capture type, and 
 (3) a fusion capture type, the fusion capture type including at least partial intrinsic cardiac function fused with at least one of partial His-bundle capture, myocardium-cell-to-myocardium-cell capture, and AV node capture. 
 
     
     
       4. The system of  claim 1 , wherein the processor is configured to provide the classification of the multiple cardiac cycles to an external module; and
 wherein the external module is configured to display a classification trend using the information about the classified cardiac cycle. 
 
     
     
       5. The system of  claim 1 , wherein the processor is configured to determine a complete or partial His-bundle capture threshold using the determined characteristic. 
     
     
       6. The system of  claim 5 , wherein the processor is configured to include a His-bundle capture template and to compare the determined characteristics with corresponding characteristics from the His-bundle capture template, and to determine a His-bundle capture threshold using the comparison. 
     
     
       7. The system of  claim 5 , wherein the processor is configured to determine a first His-bundle capture threshold for a first pacing waveform and a second His-bundle capture threshold for a different second pacing waveform. 
     
     
       8. The system of  claim 5 , wherein the processor is configured to determine a first His-bundle capture threshold for a first pacing configuration and a second His-bundle capture threshold for a different second pacing configuration. 
     
     
       9. The system of  claim 8 , wherein the processor is configured to include at least one of:
 (1) a preferred pacing configuration; 
 (2) a pacing threshold; or 
 (3) a His-bundle capture quality; and 
 wherein the processor is configured to recommend one of the first or second pacing configurations based on the at least one of: 
 (1) the preferred pacing configuration; 
 (2) the pacing threshold; or 
 (3) the His-bundle capture quality. 
 
     
     
       10. The system of  claim 5 , wherein the processor is configured to include one or more characteristic from a myocardium capture template that correspond to the determined characteristics, and wherein the processor is configured to compare the determined characteristics with corresponding characteristics from the myocardium capture template, and to determine a His-bundle capture threshold using the comparison. 
     
     
       11. The system of  claim 5 , wherein the processor is configured to include one or more characteristics from a His-bundle capture template that correspond to the determined characteristics, and wherein the processor is configured to compare the determined characteristics with corresponding characteristics from the His-bundle capture template, and to determine a myocardium capture threshold using the comparison. 
     
     
       12. The system of  claim 5 , wherein the processor is configured to include one or more characteristics from a myocardium capture template that correspond to the determined characteristics, and wherein the processor is configured to compare the determined characteristics with corresponding characteristics from the myocardium capture template, and to determine a myocardium capture threshold using the comparison. 
     
     
       13. The system of  claim 7 , wherein the processor is configured to include at least one of a pacing threshold or a His-bundle capture quality, and wherein the processor is configured to recommend one of the first or second waveforms based on the at least one of the pacing threshold or the His-bundle capture quality. 
     
     
       14. The system of  claim 1 , wherein at least one of the characteristics of the received electrical information includes at least one of a width or an amplitude of a QRS complex. 
     
     
       15. The system of  claim 1 , wherein at least one of the characteristics of the received electrical information includes at least one of a slope or a latency of a QRS complex. 
     
     
       16. The system of  claim 1 , wherein at least one of the characteristics of the received electrical information includes at least one of:
 (1) a contractility measure; 
 (2) a synchrony measure; 
 (3) a cardiac output; or 
 (4) an indication of a repolarization time. 
 
     
     
       17. A system comprising:
 a cardiac stimulation circuit configured to generate a stimulation energy to provide His-bundle stimulation for multiple cardiac cycles; 
 a cardiac sensing circuit configured to receive electrical information from the heart over at least a portion of the multiple cardiac cycles; and 
 a processor configured to determine characteristics of the received electrical information from the heart over the at least a portion of the multiple cardiac cycles using the received electrical information, the characteristics corresponding to individual ones of the multiple cardiac cycles; 
 wherein the processor is configured to determine a His-bundle capture threshold using the determined characteristics; 
 wherein the processor is configured to classify each cardiac cycle of the multiple cardiac cycles as a capture type using the respective determined characteristics, wherein the classifying includes distinguishing, for each cardiac cycle, a complete His-bundle capture type from a partial His-bundle capture type, and wherein the processor is configured to determine a His-bundle capture percentage, using information about the classified cardiac cycles; and 
 when the His-bundle capture percentage is less than a threshold percentage, the processor is configured to determine a different His-bundle capture threshold. 
 
     
     
       18. A system comprising:
 a cardiac stimulation circuit configured to generate a stimulation energy to provide His-bundle stimulation for multiple cardiac cycles; 
 a cardiac sensing circuit configured to receive electrical information from the heart over at least a portion of the multiple cardiac cycles; and 
 a processor configured to determine characteristics of the received electrical information from the heart over the at least a portion of the multiple cardiac cycles using the received electrical information, the characteristics corresponding to individual ones of the multiple cardiac cycles, wherein the characteristics of the received electrical information include characteristics of QRS complexes associated with respective ones of the multiple cardiac cycles; 
 wherein the processor is configured to classify each cardiac cycle of the multiple cardiac cycles, using the respective determined characteristics, wherein the classifying includes distinguishing, for each cardiac cycle, a complete His-bundle capture type from a partial His-bundle capture type.